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INS AN'IT Y :

Its Dependence

PHYSICAL DISEASE.

READ BEFORE THE MEDICAL SOCIETY OF THE STATE OF NEW
YORK, AT ITS ANNUAL MEETING, FEBRUARY, 1871,

BY JOHN P. GEAY, M. D.,

SUPERINTENDENT OF THE NEW YORK STATE LUNATIC ASYLUM.

^ S

-» >-A

I:RS A^ITT :

Its Dependence

PHYSICAL DISEASE.

READ BEFORE THE MEDICAL SOCIETY OP THE STATE OF NEW
YORK, AT ITS AKNUAL MEETING, FEBRUARY, 1871, '

BY JOHN P. GRAY, M. D.,

SUPERINTENDENT OF THE NEW YORK STATE LUNATIC ASYLUM.

UTICA, K Y. :

ROBERTS, BOOK AND JOB PRINTER, 60 GENESEE STREET.
1871.

INSANITY: ITS DEPENDENCE

PHYSICAL DISEASE

Since my connection with the Asylum, now' over
twenty years, I have endeavored to direct my attention
and study, as far as possible, to the investigation of the
causes of insanity, and the observation of the progress
of the disease while under treatment. I early observed
that in those cases of which full and reliable informa-
tion could be obtained, the physical cause was generally
found : that some change in some part or parts of the
organism preceded the earliest manifestations of mental
disturbance: that in those cases, some diseased condi-
tion of the bod}^, outside of the brain, generally pre-
ceded the cerebral symptoms and the consequent in-
sanity. In my official re|)ort for 1863, I presented
this subject, with the intention of showing, from the
recorded cases in this institution the relation, numeri-
cally, where moral and physical causes had been attrib-
uted as the influence determining the insanity. I there
presented a tabulated statement embracing the assigned
causation, in all cases admitted uj) to to that date, with
comments, — assig:nino; as moral causes those actino-
through the emotions, sentiments, passions, and affec-
tions ; as physical, those producing their effects through

physical impairment, diseases or injuries. In 1843, Dr.
Brigham says, " witli Pinel, Esquirol, and Greorget, we
Tbelieve that moral causes are far more operative than
physical." In his first report he assigns moral causes
in 128 cases ; physical causes in 93 cases ; unknown and
doubtful in 55 cases.

Of the moral causes 50 are attributed to religious
anxiety. I then expressed my conviction that more
careful observation would reveal physical causes as pro-
ductive of more insanity than moral causes, and that
religious excitement and anxiety had but slight influ-
ence in this direction. The annexed table embraces
the analysis of causation, moral and physical, in all
cases admitted up to this date.

I then expressed the following views on this subject:

" Here we have a gradual and marked decrease in moral,
and increase in physical causes. This is neither accident
nor design. It results from experience and recorded
facts. Insanity, for many centuries, was not recognized
as a disease ; but as a moral state, and in some a spir-
itual or demoniacal possession, and influenced by the
moon. Many of the older medical authorities refer to
and describe demonomania as a form of mental disease.
The disenthrallment of the professional, as well as the
public mind, on this subject, has been slow and gradual.
However, we have similar ignorance and superstition in
other fields of medical research.

"The question of the causation of insanity, is one of
the most important with which we have to deal. If in-
sanity is immediately developed from religious anxiety,
excessive application to study, or giving way to the

emotions of grief or joy, from the intoxication of suc-
cess or fi'om disappointed ambition, society must be
guarded and admonisbed in those directions, and the
treatment of persons insane from these causes must be
such as to meet successfully the ever present causative
influence. If, bowever, those apparently suffering from
profound religious depression, or from the other moral
causes named, are ascertained to be so affected because
of certain bodily conditions, the successful means of
treatment will be very different. If we find tbat in-
sanity is dependent on causes which tend to depress
the vital forces, and we discover these causes, we ap-
proach the question of the control of the disease and
its limitation. If we find these causes, instead of sub-
tle, moral influences, mainly physical, we advance still
further toward control and limitation, as tbe latter are
more within the power of individuals and of the pro-
fession, than the former. Think of having, within a
single year, fifty persons wbom you believe to be insane
from religious anxiety, and those from all Christian de-
nominations. What a store of theological knowledge
the physician must possess, and what subtlety of reason-
ing to meet all these cases. This number was attributed
to this cause tbe first year, twelve to excessive study,
and fourteen to fright, disappointed ambition, political
excitement, and jealousy.

These and kindred causes were recognized less and
less as efficient influences in the production of disease,
in tbe lifetime of Dr. Brigham, under the liglit of ex-
perience. The first year religious anxi'ety represented,
in tbe table of causes, eighteen and 15-100 per cent.,
the second year nine and 81-100 per cent., the third

year eight and 15-100 per cent., the fourth year fi\re and
92-100 per cent., the fifth year seven and 22-100 per cent.,
and the sixth year (the Last report made by Dr. Bvi^-
ham,; six and 40-100 per cent. There was also equally
marked diminution in other supposed moral causes, and
increase in physical Thus we perceive that more ex-
tended experience, and more careful observation of
these cases, revealed the existence of disordered physical
health as the efficient cause of insanity, and the relig-
ious depression, or other moral manifestations, as only
exciting causes, or as incidental effects. This estab-
lished, was an important advance. Rest, nutrition,
medication, could then be presented, in truth, as the
relief of sorrow. The decrease of religious anxiety,
as an attributed cause of insanity, has therefore not
been because people have been more or less religious at-
one period than another, or that new religious views
have in the meantime been advanced. It is simply be-
cause of the steady progress of medical knowledge,
deduced from patient investigation, intelligent observ-
ation, and careful analysis of facts. Upon this point,
then, what have we j)ractically gained ? These cases,
thus understood, may be properly inquired into by
spiritual as well as medical advisers, through their
physical condition, and the sufferers themselves, espe-
cially in the earlier stages of melancholia, (the form of
mental disease of which religious depression is so often
an accompaniment,) will, when assured that their su-
preme unhappiness is but reflected from their ph^^sical
depression, be more likely to understand their condition,
and to appreciate and acquiesce in the necessary reme-
dies for their restoration. Again, what an amount of

anguisli among friends is removed by tlie knowledge
tliat this depressed state and awful sense of sin and
guilt, of being forsaken of God and man, is indeed only
a cloud witliout Avind or rain — a weary, darkened spirit
from weakness of the flesh — a shadow^ which will be
dissipated on returning health, as the sun chases away
the night by his coming.

The solution of cases, under this cause, is the solution
of causation in melancholia in general, and of many
cases, under other forms of mental disease, supposed to
be dependent on moral causes, especially jealousy, sus-
picion, grief, excessive study, and kindred influences. I
have too frequently witnessed these supposed troubles
vanish under returning health to doubt on this matter.
To discover, then, under such supposed moral causes,
that the true source of disease lies in physical disorders,
is equivalent to substituting rest, sleep, food and medi-
cation for moral reasonings and diflicult and vexed
theological problems, and thus to bring the case within
the range of medical skill. If these means will dispel
the delusion of having committed the unpardonable
sin, or of being turned into beasts or demons, and re-
lieve and remove that general sense of intolerable mis-
ery w^hich impels so many to attempt self-destruction,
as the only possible means of relief, then the physician
will feel hopeful in the labor before him. We indeed
think it is safe to infer that religious anxiety is rarely
if ever a cause of insanity. The sublime faitli of
Christianity is rather a safeguard against it, and is un-
questionably a support under its scourging. We do
not believe that insanity is produced by this cause
directly, by a profound impression made through the

sentiments and emotions upon the nervous system ; or
indirectly by gradually undermining tlie general healtt.
It will liardly be argued that depression is a phase of
religious experience. As a general thing, the most
wretched melancholies are members of churches, and
often are the most humble and exemplary. However,
a full answer in our experience is in the fact that this
class of patients are gradually relieved of all depression
and anxiety as health returns, and free from it on its
full restoration."

Investigation and clinical observation constantly
strengthen the conviction that more careful inquiry in-
to this subject, by a more searching examination in
each case on admission, and more patient and exhaust-
ive inquiry of friends, with more thorough record and
sifting of clinical facts while the patient is under treat-
ment, would reveal, in a larger number of cases, the
real operative causes inducing insanity. Such inquiry
must also tend to place study and treatment on a true
foundation, — that is, of disease. Unfortunately, super-
stition and ignorance long prevented calm investigation,
and stamped the disease, in general estimation, and, in a
large measure, in the view of medical men, as one but
little amenable to treatment, and as mainly a condition
demanding custody for safety. And this state of things
unhappily still exists to such a degree as greatly to em-
barrass inquiry, and can only be dissipated by such in-
vestigations as will place insanity in the category of
nervous diseases, to be studied and treated as other
bodily diseases.

The history of hospitals for the insane for many
years past is an invincible argument in this direction.

Their transfer to the exclusive care and control of med-
ical men ; the increase of the medical staff of hosj^itals ;
the disuse of harsh and cruel means of restraint ; the
greater attention to medication, diet, ventilation, and
all hygienic means ; all indicate the subordination of
custodial to medical considerations in the conduct of
such establishments. JPost mortem examinations have,
in many cases, verified the assumed patholical causa-
tion, and revealed the consecutive changes in the pro-
gress of the disease and the relations of symptoms ob-
served to these changes, in a sufficient number of cases,
to justify and encourage more careful and exhaustive
investigation. Besides, the advance in physiological
and pathological anatomy, in the progress of medical
science, offers constantly increased and more reliable
means of prosecuting such inquiries. The special atten-
tion now given to the nervous system, by the most able
observers, is a further inducement to push inquiry in
every possible direction, but especially toward changes
in the functions or organic structure of the nervous sys-
tem, that can throw any light on the subject. Agai]3,
the vast number of insane, and the j)ossible fact of in-
crease of the disease beyond the ratio of the increase of
population, makes it all the more important and imper-
ative that no opportunity should be neglected which
promises the least light or relief

Two years ago I recommended the appointment of a
special pathologist, that such investigations might be
made as are demanded by the progress of medical sci-
ence. The managers of the asylum responded to this
recommendation, and the results were so satisfactory,
that I felt fully justified in asking that the appointment

should be made a permanent addition to tlie medical
staif. The facts and reasons for this were contained in
my last annual report. Before it was transmitted to
the Legislature, the portion relating to pathological
work was submitted to His Excellency, Govenor Hoff-
man, who, in his annual message, made the following
recommendation :

" In connection with the subject of insanity, I respectfully sug-
gest that you will give favorable consideration to the application
which will be made on behalf of the State Asylum at Utica, for
authority to appoint a special pathologist for the duty of making
such investigations as seem to be now demanded by medical sci-
ence. The reason for this will be fully stated in the report of the
superintendent of that institution, which will be transmitted to
the Legislature."

A bill was passed by the Legislature authorizing the
appointment of a pathologist, and Dr. E. E. Hun, who
had filled the place for a year, was appointed. The
course I suggested last year was to embrace —

" First. Examination of secretions in all stages of the disease."

" Second. The pulse under the sphygmograph to determine its
force and character, and wdiether any, and if so, what co-incident
relations its various phases may bear to physical states and psycho-
logical manifestations."

" Third. The pulse under the sphygmograph to show the influ-
ence of medicines on the circulation."

" Fourth. Examination with the ophthalmoscope to ascertain
the relations of morbid changes in the optic nerve, vessels, &c., of
the eye, to pathologic conditions of the brain and its membranes."

" Fifth. The skin, its temperature, color, elasticity, sensibility,
&c., in the several forms and stages of the disease."

" Sixth. Post mortem appearances, generally, and microscopic-
ally."

" Seventh. Photographic representations of morbid conditions
and specimens."

The experience of another year has given no cause to
change that course of investicraticn.

While experience shows that the morbid conditions
of organs and tissues more frequently act on the "brain
than the converse, and thus disease of special organs,
and general ill health fi'om lowered vitality, precede
and become the cause of the morbid state of the brain,
ultimating in insanity ; still there are cases where the
general ill health and the insanity are due to an over-
worked brain, or the anxiety and prolonged tension and
sleeplessness v/hich are often the result of grief and pe-
cuniary losses. Even here, however, the cause is phys-
ical, because insanity comes on only as a result of defec-
tive nutrition in the tissues, those of the brain included ;
the sleeplessness and dej)rivation of rest acting power-
fully, not only against appetite and the simple ingestion
of food, but also by wearying the nerve-tissues, and pre-
venting ultimate cell nutrition. Thus some persons fail
suddenly and rapidly, and die unexpectedly. We say
these die of exhaustion. But they are not always ema-
ciated, and thus exhausted. The brain gives way, fails
in vital energy, and death ensues. Here the morbid
action is not in the nature of shock, — of sudden arrest
of heart-action by a sudden and powerful impression
on the brain, — but of tension and wearing effort, stead-
ily and powerfully depressing the vital energy.

We see constantly the influence of mental exercise
and occupation on the health and growth of the brain.
We recognize here the physiological law, that due exer-
cise of an organ promotes its development and power.
We recognize also a limit to this occupation, beyond
which it is injurious. A child can not profitably, or
consistently with health, occupy the brain beyond a
certain number of hours without rest. If mental work

is pushed too far in cliildren, growth may be arrested
and cerebral development also. A development in bod-
ily size may proceed, but the structure may be delicate.
It is unquestionably true, also, that many bright child-
ren, under attempts at over-education, exhaust the vital
energy, and recuperative growth in brain-tissue is
lowered, while the animal functions are carried on well.
The boy developes a strong, well-proportioned body,
but is dull. Many parents and teachers are thus dis-
appointed. This law, which runs through growth, ap-
plies equally to maturity ; however, with this difference,
that in maturity excesses bear fruit always in disease.
And it may be truly said that, as a rule, the brain is
the last part of the organism to yield to disease, even
under its own overwork and excesses. Says Dr. Gull,
" the flatulent dyspepsia of the student, the tears of the
distressed, the dry mouth of the anxious, and the jaun-
dice of fright, daily remind us how far the cerebral in-
fluence extends."

In insanity, therefore, we have the dominating organ
always deranged in function if not further. Whatever
the cause may be, physical or mental, or whether the
brain is primarily or secondarily aflfected, the condition
in insanity is cerebral disease. Disease is what we have
to deal with. Not disease of mind, for the mind, the
spiritual principle, the immortal being, can not be the
subject of disease. The manifestations of the mind are
disturbed and disordered when the brain, which is its
organ, suffers. How mind and body exist here together
in harmony in health, is quite as inexplicable as their
disturbed relations in disease. Inquiry may never be
able to solve the mystery of the relation between

thouglit and the physical organism. " This our facul-
ties are incompetent either to decide or to discover, but
this short-coming of man's intelligence affects neither
his duties nor his hoj)es, neither his fears nor his aspira-
tions." [^RoUeston.']

The expression " disease of mind " should have a place
in the nomenclature of modern medical science with
witchcraft and demonomania. They are alike the off-
spring of metaphysical speculation, alike misinterpreta-
tions of phenomena. Plato and Hippocrates, in their
day, respectively represented the metaphysical and
medical aspects of this disorder of the brain. Plato
considered insanity, on the whole, a blessing. " A suf-
ficiently clear |)roof that the Deity assigned prophetic
power to human madness is found in the fact that no
one in his right senses has any concern with divinely
inspired and true prophecy, which takes place only
when the reasoning power is fettered by sleep, or alien-
ated by disease or by enthusiasm." \_Timoeus.~\ Again :
" The greatest blessings we have spring from madness,
when granted by divine bounty. For the prophetess at
Delphi, and the priestesses of Dodona have, when mad,
done many and noble services for Greece, both privately
and publicly ; but in their sober senses little or noth-
ing." [JPlioedius.^ Says Hippocrates : " Men ought to
know, that fi^om nothing else but thence [the brain] come
joys, despondency and lamentations. And by this, in an
especial manner, we acquire wisdom and knowledge,
and see and hear and know what are foul and what are
fair, what are bad and what are good, what are sweet
and what are unsavory ; some we discriminate by habit,
and some we perceive by their utility. By this we dis-

tinguisli objects of relisli and disrelist, according to the
seasons; and tlie same things do not always please us.
And by the same organ we become mad and delirious,
and fears and terrors assail us, some by night and some
by day; and dreams and untimely wanderings, and
cares that are not suitable, and ignorance of present
circumstances, desuetude and unskillfulness. All these
things -we endure from the brain when it is not healthy."
To the philosopher or metaphysician, insanity is what
they may choose to make it. To one of the sublime
faith of Plato, who referred all the phenomena of na-
ture which he could not interj)ret to a divine power, it
is not strange that insanity should seem to be from the
gods. Others, from another stand-point, have consid-
ered it also supernatural, but have assigned the phe-
nomena to the influence of devils. To Hippocrates, who
was a patient, earnest physician, who, with wonderous
success, studied morbid j^henomena, insanity was from
an " unhealthv " brain. To others, ag-ain, to whom
faith is not given to believe more than they can see
and understand, or who do not choose to believe more,
mind and all mental phenomena are mere ]3hysical re-
sults : mental manifestations of whatever order, hopes,
fears, joys, sorrows, immortal longings, deep affec-
tions, are, like hunger and thirst and pain, but expres-
sions of a physical organization ; the restless mind
of man, instead of beino; all we believe of it, an immor-
tal spirit manifesting itself in this life and in this body,
preparing for a life to come, and using the brain as an
organ or instrument for its purj^oses, is a mere secretion
of the brain, depending: on its existence, and sickenins:
and dying with it. Are we to account for anger, rage,

jealousy, grief, and all the violent manifestations of the
]3assions, 'as physiological states or disturbances of
"brain secretions?" In physiology, causes and results
must bear a uniform relation ; and we should have for
so much grief so many tears, for so much provocation
so much ano'er, and the like. Instead of having^ varied
manifestations in the same individual, as well as in dif-
ferent individuals, from the same causes, the manifesta-
tions should be uniform. Cabanis, Avho wrote nearly
a century ago, expressed the materialistic theor}^ thus :

" To obtain a true idea of the operations by which thought is
eliminated, the brain must be considered as a particular organ,
especially designed for its ]3roduction ; even as the stomach and
intestines for carrying on digestion, the liver for secreting the bile,
the parotid and maxillary and sublingual glands for the prepara-
tion of the salivary secretions.

" Impressions, on reaching the brain, stimulate it into activity ;
as aliments, being introduced into the stomach, excite it to a more
abundant secretion of the gastric juices, and to those movements
which favor their proper assimilation. The natural function of
the one is to receive every individual impression, to attach to it
certain indices, to combine the different impressions, to compare
them among themselves, to draw from them certain judgments and
determinations ; as the function of the other is to act upon nutritive
substances, whose presence stimulates it, to dissolve them, and to
assimilate their juices to our nature.

" If it be said that the organic movements by which the functions
of the brain are executed are unknown to us, it may be i-eplied that
the action by which the nerves of the stomach determine the dif-
ferent operations constituting digestion, the manner in which they
impregnate the gastric juices with the most active dissolving power,
do not disclose themselves more to our researches ! We see the ali-
ments pass into the viscus, with new qualities, and we conclude
that it has really caused them to undergo this alteration. We
equally see impx-essions arise to the brain through the medium of
the nerves; they are then isolated and without coherence. The
viscus enters into action; it acts upon them, and soon it evolves
them transformed into ideas, of which the language of phys-
iognomy and of gesture, or the signs of speech or writing, are the

outward manifestations. We conclude with the same certainty
that the brain in some manner digests the impressions ; that it
produces organically the secretion of thought.

This, then, fully resolves the difficulty raised by those who, re-
garding sensation as a passive faculty, do not understand how the
acts of judging, reasoning, imagining, should be nothing else but
perceiving. This difficulty vanishes, when we recognize, in all
these different operations, only the action of the brain upon the
impressions which are transmitted to it.

"But if, moreover, we observe that the movement, of which
every action of the organs presupposes the existence, is in the
animal economy only a modification, — a transformation, — of sensa-
tion, we shall see that we are excused from making any changes in
the doctrine of the modern analysts, and that all the physiological
or moral phenomena are always brought back, in the last result, to
the faculty of sensation." [Cabanis, Rarpports du Physique et du
Moral de V homme^ vol. i, p., 124.]

Recently Dr, W. A. Hammond, of New York, in a
work on " Slee])^ and its Derangements^^'' Las reasserted
tkis old theory, and expresses liis views of mind in tlie
following language :

" Writers who contend for the doctrine of constant mental activ-
ity, regard the brain as the organ or tool of the mind ; a structure
which the mind makes use of in order to manifest itself Such a
theory is certain to lead them into difficulties, and is contrary to
all the teaching of physiology. The full discussion of this question
would be out of place here ; I will, therefore, only state that this
work is written from the stand-point of regarding the mind as
nothing more than the result of cerebral action. Just as a good
liver secretes good bile, a good candle gives good light, and good
coal a good fire, so does a good brain give a good mind. When
the brain is quiescent there is no mind."

It will tlius be seen tliat the introduction of material-
istic theories, even into the domain of psychology, is
nothing new. Neither is Cabanis the only French
writer who has pushed Locke's theory of sensation to
its ultimate results of materialism and atheism But it
would be a thing much to be deprecated, that the gen-

erous and catholic spirit of modern scientific investiga-
tion should be narrowed and hindered by an attempt
to revive the exploded vagaries of the French material-
ism of the encyclopedists and the Revolution. The best
writers of the present day, however, if they refuse to
bend the conclusions of science in the interests of re-
ligion, on the other hand will much less consent to
commit science to a purely conjectural theory, which
militates a2:ainst moral order and social welfare no less
than against the common sense of mankind.

We do not look at mind from the stand-point of re-
garding it " as nothing more than the result of cerebral
action," and therefore as a material substance, a mere
secretion liable to disease and death. We res-ard the
brain as the organ of the mind, and we cannot perceive
that such a theory conflicts v\^ith physiology or is con-
trary to its teachings. If the mind is a material sub-
stance, a secretion of the brain, as bile is a secretion of
the liver, then the sublime faith of the Christian religion
is of little consequence to man, and they who work for
the advancement of medical science truly labor in vain.
If, however, this body is what Kevelation declares it to
be, (the temple of the mind or spirit which in it dwells,
awaiting a life to come,) and what science shows it to
be, a living organism, under definite laivs^ then it is
worth our care, as the dwelling-place of an immortal
being.

Says Dr. Acland, in an address at Oxford, before the
Medical Association of Great Britain and Ireland, when
taking the chair as President, — " The physician sees in
the body of man the material structure by which alone
the known operations of the mind of man are possible

in this world, tlie organs by wliicli alone lie can work
his earthly work, whether it be the work which he
shares in common with the beasts of the field, or the
work through which he can enter into conscious rela-
tion to his unapproachable Creator : the frame by which,
while bound down in an earthly charnel-house, he lifts
his eyes and strains his heart with yearnings ineffable
towards a higher nature, and obeys the upward-tending
impulses of affections strong unto death, affections so
pure and so divine as to lose in the love of others even
the consciousness of self."

We do not believe that mental phenomena can be
accounted for by physiology, much less that the teach-
ings of physiology necessitate or even lead to materi-
alism.

Professor RoUeston, who stands in the foremost rank
of teachers in Physiology, uses this emphatic language :
" The Physiologist as such has nothing to do with the
data of psychology, which do not admit of being weighed
or measured, nor of having their force expressed in in-
ches or ounces." Psychical manifestations, mental phe-
nomena, he declares to be " facts in just as true a sense
as any which scalpel or callipers, which weights or
measures, can disclose ; " and holds " that our higher
and diviner life is not a mere result of the abundance
of our (brain) convolutions." And again: "I believe,
however, that, if men would take as much and the
same care in these psychological questions as the phys-
iologist does in his experiments and observations, to
overlook none of the conditions and circumstances of
the entire complex of phenomena upon which they un-
dertake to decide, they would come to see that alone.

and often Ibeliind, but always beside and even beyond
the wliiii of his emotions and the smoothly fitting and
rapidly playing machinery of his ratiocinative and other
mental faculties, there stands for each man a single un-
decomposable something — to wit, himself. This some-
thing lives in his consciousness, moves in his will, and
knows that for the employment and working of the en-
tire apparatus of feelings and reasonings, it is individ-
ually and indivisibly responsible. Its utterances have
but a still small voice, and the turmoil and noise of its
own machinery may, even while working healthily, en-
tirely mask and overwhelm them. But if we with-
draw ourselves from time to time out of the smoke and
tarnish of the farnace, we can hear plainly enough that,
howsoever the engine may have come together, and with
its present being, the engineer^ at all events, is no re-
sult of any j^rocess of accretion and agglomeration.
Science, business, and pleasure are but correlations of
the machinery in its different applications and activities ;
we are something beside all this, manifesting ourselves
to others in the decisions of our loill, and manifestino-
ourselves to ourselves in our aspirations and conscious-
ness of responsibilities."

Says Mr. Herbert Spencer: "It may be safely affirm-
ed that physiology, which is an interpretation of the
physical processes which go on in organisms in terms
known to natural science, ceases to be physiology when
it imports into its interpretations any psychical factor,
a factor which no physical research whatever can dis-
close or identify, or get the remotest glimpse of."

Prof. Lionel S. Beale says: "Every one will admit
that the nerve-tissue of the brain is the instrument

tbrougli wliich alone tliinking power works and mind
acts." He subsequently tlius disposes of tlie materalis-
tic theory of mind:

"Some have looked upon brain as a sort of gland by Avhich
thoughts and ideas are formed or secreted, as if thought, which
can neither be touched, weighed, measured, or in any way physi-
cally estimated, was a thing allied to the bile, the saliva, or the
gastric juice, which are material substances, and can be analyzed
and otherwise experimentally studied. It would not be more un-
reasonable to maintain design or will to be a part of the material
framework of the organism, than to assert that mind, like certain
kinds of matter, is secreted. Thought is no more material than
that peculiar capacity which makes living matter of a certain kind
at length become oak, cabbage, dog, man, etc. Nay, it is further
removed from the material, for while this property or power influ-
ences the very particles of matter, and makes them take up cei-tain
fixed and definite positions, thought only produces a sort of evan-
escent vibration, which results in the expression of ideas which are
themselves as immaterial as the thought itself.

" Mental enei-gy has been regarded as the function of the brain,
but if it be so, it is ■Si function of a very different order from that dis-
charged by other organs. Function implies an act in which will,
purpose, design, are not concerned, and in which material changes
can be proved to take place. The function of a gland is to pro-
duce a secretion. Certain conditions necessitate the production of
this or that particular secretion, which may vary to some extent,
according as the conditions are changed. The function of a mus-
cle is to contract and become relaxed, but the material change
only occurs in definite directions, necessitated by the structure of
the instrument and the force which acts upon it. The exercise of
choice is neither possible nor conceivable. So, too, with reference
to the function of nerves. These transmit currents. The paths
which the currents are to traverse having been determined and
formed, the currents are developed and transmitted along the
nerves.

" But Xho. function of the organ of the mind is an operation very
different from any of these. Its great characteristic is choice —
selective capacity. If the cells of the liver chose for themselves
whether they would secrete bile or not, or determined the kind of
bil3 to be secreted, or the bile chose for itself by which ducts it
should pass, whether it should flow quickly, slowly, or not at all ;
if the muscle contracted now in one part and now in another, ac-

coi'ding as it willed — if it elected to contract in one direction, and
then in a different one ; if the nerve cells decided among themselves
which should produce current and which not ; if the cmTent chose
to run along one fibre at one time and then along another, accord-
ing to the object it had in view — then, but only then, as it seems
to me, could inental activity be regarded as in any way analogous
to the function of an organ or of a tissue. To look upon mental
action as a mere function of the brain is a fundamental error, and
unpardonable in those who have really studied the structure and
action of secreting organs and nerve organs.

"Mental activity may rather be compared to that marvellous
power, property or force, which enables the liver cell to form what
we call bile, which renders possible that change in shape of the
ultimate particles of muscle which gives rise to contraction, and
determines the change in the ultimate molecules of nerve matter
upon which the current depends ; but this power is not the func-
tion ; it is that which alone renders function possible. But even
this comparison is not a true one, for the power above referred to
acts as if it were of some necessity, while the remarkable character-
istic of mental action is freedom of choice. Certain conditions
given, the liver cell onust form bile, the muscle mKst contract, the
nerve cell must give rise to, and the nerve fibre must transmit, the
current ; but is it conceivable that under certain conditions actual
or supposed, the brain m^ust think ? Is what I am now writing but
the result of the distribution of a little extra proportion of certain
nutrient constituents and oxygen to my nerve cells, which thereby
compels me to say all these things ? Have I no choice ? — must I
say all this, and in the precise way in which it is here said ? All
these things would surely have been said in a far better and more
perfect manner if the ideas had been formed like a secretion by a
gland, independently of experience and without any efforts of my
own. All our glands perform their work perfectly when their
formation is complete. They require no teaching, and they work
without effort. There is nothing in the action of a gland which at
all corresponds to the improvement in capacity resulting from ex-
ercise, which is so remarkable in the case of cerebral nervous ac-
tion. The general tissues and organs at least of those persons who
have reached or passed middle age, performed their functions some
years ago as well as, and I fear in some resj^ects even better than
they do now. Will has exerted, and can exert, no direct influence.
But it is very different in regard to the organ of the mind and the
the tissues concerned in intellectual action. Every one knows that
the degree of perfection which that has attained, or will attain, is
determined in great measure by his own efforts — by his own will.

The thinking instrument of one individual is not capable of being
perfected in the same degree as that of another, but it is quite cer-
tain that each may be improved and made to work more perfectly,
if its possessor determines that this shall be ; nay, I think I may
say, if he will not interfere actively to prevent its improvement ;
for the natural tendency of the mind is to exercise itself, and, in
doing so, the instrument, which it directs, necessarily improves.
As the mechanism becomes more perfect, the pleasure afforded by
its working becomes greater, and to real desire and sustained effort
on the part of the mind soon succeeds improvement in the structure
of the healthy instrument by which the attainment of the end de-
sired is rendered possible." \_Med. Times and Gazette^

Dr. Thomas Huii, in an article in the Ameeicaist
JoTJEisrAL OF IjsrsAT^iTY, in 1846, on the '-'■ Relations of
Physiology to Psychology ^^"^ says : " Some have denied
the existence of mind, and have made thought an attri-
bute of the substance of matter. These are the materi-
alists. Others have made matter only a mode of mani-
festation of mind. These are spiritualists. While
a third class have endeavored to find a third term
which should include both matter and mind." These
classes have been denominated Somatists, Psychists,
and Somato-Psychists. Under either theory of investi-
gation. Dr. Hun, at that early day declared it impracti-
cable to advance in psychology, and experience has
verified this, as shown by the declarations of RoUeston,
Spencer, and Beale. "We have to study," says Dr.
Hun, " not the nature of the two substances, nor the
nature of their relations, but this relation itself as it
manifests itself to the senses and to consciousness. The
great questions for us to answer are these : what nerve
movements corres23ond to given mental acts ? what is
the mechanism of these movements ? and how are the
mental acts affected by changes in the nervous matter
in the rest of the body ? Physiology

is a science of facts cognizable to the iive senses, and
uses tlie same modes of investigation as tlie other physical
sciences. Psychology is the science of mind. It is
founded on facts of consciousness which are not cog-
nizable to the senses. It embraces all the mental opera-
tions, which are very different from changes in nervous
matter, and hence psychology is not merely a chapter
of physiology, but a separate and independent science."

To sum up this whole subject, there are to be observed
two prominent and vitally important points, which, to
our mind, demonstrate the utter falsity and even im-
practicability of the materialistic theory of mind. One is
spontaneity / the other, responsih ility. The idea or notion
of spontaneity we know to be a reality of our own con-
sciousness, as patent and demonstrable as any fact of sci-
ence, and yet, to use the precise and clear-cut scientific lan-
guage of Herbert Spencer, it is impossible to make this
spontaneity a "factor" in any mere natural or physical
process whatever. Oar very conception of the material
altogether forbids it. Even in that last stej) where physi-
cal science approaches nearest the domain of metaphysics,
the attempt to arrive at some definition of Force itself,
the idea of sj)ontaneity is by no means begun to be
reached, or in any way involved. When it comes to
that, it comes to God himself, whatever man may choose
to name Him, " Jehovah, Jove, or Lord."

The other point, which is the notion of moral re-
sponsibility, is one remove further even than spon-
taneity, from all conception of the material and therefore
much less reducible to any physical or material process.
It would be as easy to deny in toto intellectual phe-
nomena as to deny the reality of our idea of moral

responsibility ; but tlie notion of responsibility itself is
a direct contradiction of the idea wliicli arises out of
such, a thing as physiological secretion, or any other
mere process of nature governed by definite and un-
changeable laws. It would be impossible to connect
the two, or in Herbert Sj)encer's phrase, to make them
coordinate " factors " in any intelligible result whatever.
Whatever the animus of such a position may be, the
result must be the getting rid of the idea of moral re-
sponsibility altogether. Science of this Mud, instead
of being a blessing to the world, would contribute only
to anarchy and moral disorder, even if it did not utterly
destroy the self-respect of any one who should profess
himself projficient in it.

Science needs neither doubt nor skepticism as a con-
dition for her advancement. Her aim is to discover and
read the laws and processes of nature herself, imprinted
by the Creator, and she works, to use the language of
Bacon, " Keeping the eye steadily fixed upon the facts
of nature, and so seeing their images simply as they
are." We believe that physiological science will so ad-
vance that every process in the complex phenomena of
physical life, in health and disease, shall be read and
revealed and understood.

The true and only method by which insanity can be
studied is that followed in all other diseases. The
physical lesions are the subjects of primary importance.
These must be studied through physiology and path-
ology. The mental manifestations are here secondary
and dependent. " Organs and tissues," says Dr. Gull,
" have each their own life, and correlative with it, their
own tendencies to disease, and their specific power and

mode of repair," and " the purpose of our study is to
trace tliese tendencies to tlieir source on tlie one Land,
and to tlieir effects on tlie other."

We say that insanity is a bodily disorder ; that it is
a disease of the brain. This does not imply that there
is somethino: to be thrown off, in the character of some
morbid entity. It simply means that certain changes
have taken place in the brain, or its investing mem-
branes, which imply a departure from healthy physio-
logical action, and that in consequence of these changes
there is more or less prolonged disturbance of the mind.
The physician recognizes the delirium of fever, and re-
fers its origin to the brain. The convulsions of infancy
and childhood, from the presence of worms in the in-
testines, or indigestible materials in the stomach, or the
process of teething, he refers to the brain. In the
former, he may refer the remote cause to some poison ;
but the immediate cause is a tissue-change. If this
change is gone through with within certain limits, he
looks for recovery ; if not, under further tissue-change,
the patient sinks and dies. The remote or predisposing
cause of the latter he calls morbid irritation. If the
stomach and bowels are emptied of the offending mat-
ters, and the irritation of teething relieved before tissue-
changes follow the convulsions, recovery will take place.
In other words, if the constitutional disturbance of the
nervous system, in the one case, from poison, and the
local disturbance of the nervous system in the other,
from irritation, may be relieved before certain organic
changes occur, recovery takes place ; if not, partial re-
covery, or death, results.

If the carotid arteries are pressed upon by a tumor,
or tlie circulation of tlie brain interfered witli by aneu-
rism, we liave wliat is denominated a liypersemic state
of the brain ; not a determination of blood to the brain,
but the blood detained by the vessels dilated. Clinical
study and 23hysiology have taught us to anticipate the
resulting consequences of such a state. The physician
is not surprised to find insanity follow ; but this is the
exceptional result. He is quite as likely to find failure
of the general health, from feeble action of the heart,
due to the condition of the brain. Again we have an
angemic or bloodless condition of the brain from copious
hemorrhage after childbirth, or from other causes, and
general enfeeblement results, or convulsions, delirium,
or insanity may follow. Can we, by careful clinical ob-
servation, ever be able to determine why one should re-
sult, instead of the other ? or why we may have in such
a case — convulsions, then delirium, and afterwards in-
sanity ? Can we hope to ansv^^er these questions, with-
out the aid of pathological investigations, made 2^^^^
mortem f We may be satisfied to reply that convulsion
follows hemorrhage, under the physiological law that
muscular spasm supervenes upon sudden and copious
loss of blood, because muscular irritability is thus in-
creased, and that the pathological state is one of de-
pressed vital energy, and here we have a clue to treat-
ment. Delirium following convulsion, or following the
hemorrhage without convulsion, we may also explain
under physiological and pathological laws.

Now should we stop inquiry here, when insanity re-
sults ? Can we admit that insanity is anything more or
less than a pathological condition, or that it lies beyond

the bonndaries of ordinary and legitimate medical study,
and beyond the range of clinical observation or path-
ological investigation? Will not the patient study
which elucidates one be likely to elucidate the other ?
But in the latter the mind is affected? So is it in
delirium. So is it, in a degree, in its operations, in
all diseases, when the brain is in any way involved.
So is it, when the brain is under the influence of
alcohol, or certain drugs. In all abnormal conditions
of the brain, however induced, we have a degree
of disturbance in mental operations. At a certain
stage of intoxication, there is consciousness of the fact,
and full control and direction of mental operations ;
at another stage, the brain, the instrument or organ of
the mind, as we believe, is so overwhelmed that it cannot
be used. We recognize in all these conditions simply
physical disturbance, either physiological or patholog-
ical. A proper regard for the teachings of physiology
does not require that, in the last condition mentioned,
when the brain is " quiescent," we must conclude that
" there is no mind." On the other hand, it will not be
argued, that, in these conditions of mental disturbance,
there can be either a physiological or pathological state
of mind itself! We do not treat these mental phenom-
ena ; but we regard them simply as exponents of phys-
ical states. We hold that it is not necessary, in order
to establish the physical origin and nature of insanity, or
other cerebral diseases, to show that every case is of such
origin and nature. If, in a single case, insanity is shown
to come on as the result of well-recognized bodily disease,
and the mental disturbance disajipears pari passu with
the physical restoration, the argument is invincible.

We do not treat the mental phenomena wMcli appear, as
indices of the cerebral disorder ; but we point out to the
patient his changed meatal condition, and endeavor to
show him that his delirious conceptions are delusions,
and result from the morbid condition of his brain; and
that with restoration to health these delusions and mis-
conceptions will vanish. Many may be convinced of
this ; and though the delusions do not disappear with
this conviction, yet persons may, and often do, so far
\eej) constantly in mind their true condition, and exer-
cise such control as largely promotes their recovery.
The mind, by this effort, uses the brain ; and, by the
exercise of its legitimate dominating power, moderates
its action in some directions, and increases it in others.
The mind " exercises choice," and controls itself, and by
limiting and modifying its use of its organ, the brain, aids
in the restoration of that organ. In many instances peo-
ple recognize the approach of insanity in themselves, —
not simply from vague and unusual sensations as pains
in the head, sleeplessness, etc., — but recognize a marked
change in their way of thinking, feeling, and acting;
a change which not only does not commend itself to
their judgment, but is also against and repugnant to
their wishes and desires. Under such states of mind
persons come to the asylum for advice ; and since my
connection with it, a number have come thus alone, and
insisted on admission. I have mentioned some of these
cases in my reports. In one instance, the person made
application himself to the county judge, obtained an
order for his admission, and brought it himself. An-
other case was that of a woman Avho came from a
distant part of the State, and informed me that she had

left home in tlie niglit, without the knowledge of her
family, because they did not believe she was insane,
and would not assent to her coming to the asylum:
asked me to telegraph her arrival to her family, and
write and explain to them her case. She then stated
to me how delusions developed while she was watching
over an invalid mother; that she recognized the delu-
sions, as such, but as she failed in health was unable to
do so at all times, and therefore felt she must be getting
insane. She remained, and after a time passed into a
state of acute mania, and, when apparently recovering,
committed suicide.

Another case was that of a young girl. She for
some time observed in herself pei'iods of mental depres-
sion and exaltation : after a time strong suicidal sug-
gestions came during the periods of depression, and
during those of exaltation, an idea that she was destined
for some great work in the church. She thought she
might be insane. Her health, never robust, was gradu-
ally failing. She left home in the night to drown her-
self in the canal, but on reaching it she was quite
chilled, the night being cool. She then thought her
changed condition might possibly after all be insanity,
and not the despair of a lost soul. She therefore re-
solved to come to the asylum, and state her case, and
then, if she were insane, try and get well ; and if not
considered insane, end an existence which to her seemed
only an injury to the world. She first stated her case,
and when told she was insane, related the circum-
stances above, which were verified. She actually walked
into the water. She remained in the asylum, passed
into deeper melancholia, and then became demented,

and finally recovered. Botli these women were feeble
and anaemic, tlie blood lessened in quantity, and depre-
ciated in quality.

I could present, from my recorded experience, a num-
ber of sucb illustrations, showing the appreciation of
insanity and the dominating power of mind. In the
wards of the asylum this is a daily experience. Pa-
tients not only recognize that they are insane, but make
every effort at control ; and many take food and exer-
cise,— to both of which they feel the extremest repug-
nance,— simply as a duty, and stimulated by the ho]3e
of recovery held out to them, and which hope they only
faintly grasp. While writing I am interrupted by the
admission of two cases, a man and woman. The friends
and physician of the man represent the case as a recent
one, dating but a few weeks back to some eccentric con-
duct ; and declare the case as somewhat remarkable,
because they can find no cause for the insanity. Yet a
careful examination shows that the man Las been stead-
ily breaking down in general health for two years.
That he is generally ansemic, and has cerebral anaemia
to such a degree that his pupils are not only enormously
dilated, but scarcely contract at all under the infiuence
of light. He has hallucinations of sight and hearing,
from this condition. He moves about the office like a
man half dreaming : admits he is sick, but does not see
why he should be called crazy. When asked how he
reconciles certain conduct with sanity, says he never
was guilty of it. When all the circumstances are rela-
ted to him, he replies, " I have some recollection of that,
but I do not know why I did it." He has great muscu-

lar languor, lias passed the ]3eriod of cerebral excite-
ment, and IS dementing.

The woman denies her insanity. Says she is a great
magnetic healer; has received the baptism of the Holy
Ghost, and nnctiou from Grod ; that her mind has been
illuminated so that she understands science, because it
is revealed to her ; that she will let the world know
this change, and intends to speak in Mechanics' Hall,
in Utica, and show what true religion is, and what
magnetic healing is. She admits she has not been well
for months, and has suffered from intense headaches;
but claims she is now well, better than she has been for
years. She is incoherent in conversation, exalted in her
ideas, disdainful in manner, indignant at being called
insane, threatens the consequences of confining such a
person as she is. Her muscles are tense. She moves
about the office with great muscular firmness, and spas-
modically closes her hands and compresses her lips.
She is ansemic, almost colorless. Her pupils are greatly
dilated ; her gums and tongue are pale. Although she
is indignant, angry, her emotions wrought up to a high,
point, and she is on the verge of maniacal raving, she
does not change color. This woman's whole appear-
ance, conduct, and manner of speech, are in direct con-
trast with her character in health. The anaemic state of
the brain is the cause of the insanity. The muscular
S3^stem is in a state of abnormal activity, " a neuro-
pathology from the brain to the tissues." This patient
has good appetite and digestion, and says she is free
from all pains or uncomfortable sensations. Has this
woman disease, as that term is ordinarily used and un-
derstood in medicine, or is the brain, in the language of

materialism, "secreting force "^" of abnormal quality?
We say, the mental phenomena are due to the anaemic
condition of the brain. This woman has a large active
brain, and it dominates over the whole organism, in its
present state. While she is really in a state of debil-
ity, the brain exercises power over the voluntary mus-
cles quite as fully in this state of irritation, with a
pulse under 80, as it would in the vascular activity of
fever delirium, with a pulse over 100. However,
the cause to be truly assigned in these cases, is the
generally depressed health, inducing the anaemic state
of the brain, and nervous system. Both these cases are
brought to the asylum as soon as the insanity is recog-
nized, as both are surrounded by intelligent friends,
and have conscientious phycicians. The former of these
cases might have been treated at home, if his phy-
sician had received the same degree of instruction in
regard to insanity that he did in regard to apoplexy,
paralysis, and other disorders of the brain and nerv-
ous system. In contrast with this prompt action
in securing treatment, is the unfortunate delay in the
vast majority of cases until the period of recovery is
past. Such fatal delay has characterized more than
half of the 480 admitted to the State asylum this
year. Many of those received have not only suffered
from delay, but from injudicious, though well-intended
treatment. Cases of melancholia from over- work, and the
gradual failure of the tissues from age, and the conse-
quent lowered vital energy, have been bled, blistered, se-
toned, and purged. Old ulcers, which nature had kindly

*The mind of man may be defined as a force developed by nei'v-
ous action. — Journal of Psychological Medicine^ July, 1870.

healed for years, re-opened afresli, — all under the vague
general idea of counter-irritation, and this when irrita-
tion from deficient and impoverished blood was a per-
sistent pathologic state. In one case, — a feeble, old,
melancholic women, — " a mercurial, alterative course,"
was added, producing salivation.

Without raising the question as to how far we have
advanced in the recognition of the physical symptoms
of insanity; or how far we are able to diagnosticate
the disease by physical signs ; or how far we should be
able to verify a state of mind, claimed as insanity by
the physical indications present ; or how far we should
be required, in examining criminal cases, in testing pos-
sible or probable feigning, to adduce physical signs in ev-
idence ; we may truly say, that only through pathology
can we hope to advance in diagnosis. It is not necessary,
for success in this direction, that we should attempt the
study of the manner in which the spiritual being is as-
sociated with the animal existence, or to define the mys-
terious mutual relation and influences between them.
It is sufficient that we should study the morbid or dis-
ordered states of body which are competent to induce
such changes in the brain as cause that altered or de-
lusional mental state denominated insanity; and the
physical signs which indicate the existence and progress
of such brain changes.

It may be safely assumed that experience has given
us some fundamental starting points : —

1st. Disease of any part of the organism may be the
pathologic cause of insanity.

2d. In such cases insanity is not manifested until the
brain is actually involved.

3d. Disease of tlie brain or its membranes may be
tlie primary, exciting cause of insanity, and other parts
of tlie organism subsequently become affected.

4tli. Insanity more frequently lias its primary origin
in pathologic states outside the brain, than in primary
diseases of the brain.

5th. There are physical symptoms and signs of brain
diseases, which experience has enabled us to recognize
as pathognostic of certain brain-changes ; by knowl-
edge of which we are able to anticipate and understand
the progress of cerebral diseases.

While we may admit that, in a given morbid condi-
tion of the brain and system generally, the treatment
would be the same whether the brain or other j^arts of
the organism were first affected, it is nevertheless of the
highest importance to study and discover not only the
relations of symptoms and morbid conditions, but the
relations as to priority and sequence, for thus alone can
we construct a true pathology, and thus alone establish
an intelligent system of preventive treatment. If we
can know the sequence of symptoms and conditions,
we can anticipate and avert, arrest or modify the ulti-
mate result of pathologic processes. If we can, by
large clinical observation, determine what disordered
states of the system are most likely to act on the brain,
we gain an important point. It is for us to inquire,
therefore,

1st. Whether there are specific changes in the brain
in insanity, and if so, whether there are any means
of ascertaining positively or proximately what those
changes are ?

2d. Are there physical signs and symptoms indicat-
ing the presence and progress of such changes, which
may be detected and relied upon, and what these are ?

3d. Are there 2^ost mortem appearances in the brains
of those who die insane, which would justify the as-
sumption that morbid cerebral changes were the poten-
tial and only ultimate causation of insanity ?

4th. Are there any sound reasons for an assumption
that the mind can overthrow itself, independent of cere-
bral changes ?

5th. Do the secretions of the sMn, kidneys, <fec.,
throw any light upon the morbid condition of the brain
in insanity, either regarding its pathologic state, its
nutrition, or action?

The important questions in each case are : What are
the lesions? What is the physical diagnosis? The
gravity of the case is by no means measured by the in-
tensity of the mental manifestations. It constantly
happens that, associated with trifling changes, there is
great mental disturljance, and but little with more
serious lesions. What are denominated mental symp-
toms have a subordinate place in diagnosis as well as
in treatment. The mental manifestations, indeed, have
the same relation to diagnosis and treatment that men-
tal phenomena hold in delirium tremens, fevers, and
diseases of children. They are symptoms, but only
significant of conditions of the nervous system, which
conditions are to be treated. In all the disorders of the
brain, we mark carefully what symptoms or groups of
symptoms given cases manifest ; and by this clinical ob-
servation, and by a knowledge of physiological laws,
and \>j post mortem examinations we learn to interpret

tlie morbid changes going on within tlie skull. There are
no reasons why insanity should prove an exception to
this rule. Until within a few years, diseases of the
spinal cord were obscure, and the differential diagnosis
anything but certain. But the recent investigations of
Bernard, Brown-Sequard, Kussmaul, Van der Kolk,
Romberg, Radcliff, Virchow, Bouchard and other neura-
pathologists have solved many of the greatest difficul-
ties, and promise the most thorough elucidation of all.
Among the most important practical considerations,
overlooked in insanity, is the fact that organic changes
in the brain are likely to occur very soon after the first
morbid functional action is set up. To the lack of rec-
ognition of this fact must be attributed the vast multi-
tude of chronic cases. Any bodily condition which
disturbs the mind is too important to be overlooked
or ignored. Prolonged wakefulness, — though it may
not apparently disturb the mind, — indicates a condition
of the brain which is not natural, and which should be
inquired into. When this is associated with depression,
groundless apprehensions, suspicions, and uneasiness,
the case is one of grave import, and should command
medical attention. Such a condition is significant of
physical disturbance, and foreshadows insanity.

TABLE showing the analysis and the percentage of moral, physical and unascertained causes as recorded in the admissions for twenty-eight years.

ANALYSIS OF CAUSES.

1843.1844.1845.

1846.

1847.

1848.

1849.

1850.

1851. 1852.

1853.

1854. 1855.

1866.1857.

1858.

1859.

1860.

1861.

1862.

1863.

1864.

1865.

1866.1867.

1868.

1869.

1870.

Moral Causes,

128

108

106

110

127

116

100

110 117

107

96| 55
231 187

45 31 68 .57
158 157: 221| 212

12i
263 321
113! 80

296

Physical Causes,

9.3

95
132

189

160

141

242

229 261 292

237

184

197

208

242

261

378| 432

Unascertained Causes,.

162

129

121

27! 12

39| 47

PEHCENTAGE OF CAUSES.

Moral Causes,

46.38 39.27 36.18
.33.70;33.82;81.74
19.93'26.9l'32.08

32.64

29.67

28.64

27.62

23.9880.05
65.9462.57
lO.OsI 7 37

30.

28.07

24.62 20.
.59.28 68.-
16.15 12.

18.60

13.19

18.92

18.27 18.95 13.o6]ll.50
67.95 70.83 62.37 68.64

9.06

6.o8| 5.4l| 3.09| | !
75.86 73.3o|67.78 80.05 77.49 81.65

Ph^'sical Causes,

28.19

32.48

39.51

38.95
33.42

66.92

68.87

65.29

66.81

66.87

72.48

85.66

Unai^certaincf] Causes..

39.17

37.85

31.85

3.08

5.89

16.11!20.

14.65

13.78|l5.73i24.07ll9.86

18.46

17.55 21.24 29.12ll9.9o'22.51 18.35

11.34

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